The increasing number and diversity of people migrating to the United States, and in particular to California and specifically to the Bay Area, provides special challenges to community institutions. Since the majority of immigrants arrive without a working knowledge of English, schools, employers and health care institutions have a special responsibility to respond to the needs of these new arrivals. Notably in health care, the State of California has enacted legislation (SB1840) that requires all California hospitals, as of Jan. 1, 1991, to review their language services policy, to post notices of the availability of interpreters for languages represented by 5% or-more of the hospital's patient population and to provide translated versions of consent forms and other documents submitted to hospital patients.
When a patient and a physician do not share a common national language, the result can be a nightmare for the patient and a forbidding barrier to the provision of medical care by the physician. The problem begins with the crucial role of history-taking. The ability of the physician to explore the history of the present illness, past sickness episodes and possibly relevant family and social factors is a process that elevates human medical care above veterinary medicine. A misunderstanding during this initial procedure can seriously hinder the ability to provide the necessary care.
A common language is also required for a satisfactory physical diagnosis. The patient must response to the physician's request to open the eyes, to close them, to breath deeply or to stop breathing. The patient must understand so as to cooperate for a rectal or vaginal examination. Finally, the patient must be able to understand the formulation of the problem by the physician, the need for laboratory examination and for the details of a therapeutic program. Special problems are presented by labor and delivery, ambulatory surgery, and for the feasibility of psychiatric care.
Traditionally, patients who do not speak English often bring an anglophone relative or friend with them to communicate with the health care provider. This companion may have limited interpreter skills, may represent a source of embarrassment to the patient when intimate or delicate information must be solicited and/or may not be appropriately present in settings such as emergency or delivery rooms.
Hospitals have attempted to solve these problems in three ways. The first solution involves the assembly of a "language bank" of hospital employees with bi-lingual skills but with work assignments unrelated to interpreting. They are volunteers who are not paid for interpreting. Typically, the language bank staffer has had no training in interpreting. When asked to interpret, the employee must leave his or her work assignment to go and interpret in some other part of the hospital Many bi-lingual employees are immigrants at entry-level positions and their jobs may be threatened if they are called upon too frequently.
The second solution involves the employment of skilled interpreters as staff members. However, thus far, no standards have been developed to measure the quality of interpretation provided, and the performance of hospital interpreters varies from superb to marginal. The administration of language services is particularly difficult. Interpreters are summoned to various locations in the hospital and, when they arrive at the requested location, they may have to wait until provider and patient are brought together. The patient, often coming from a traditional and conservative culture, may find it unacceptable to communicate through an interpreter of the opposite sex. Further problems for the hospitals include the inefficiency of hiring staff for less-frequently encountered languages and for night and weekend coverage.
The third solution which addresses this problem is a service referred to as Language Line. On Oct. 31, 1990, American Telephone and Telegraph announced an international interpretation service available at $3.50 per minute, plus the cost of the call. Interpreters in 143 languages and dialects are on call. The program is generic and specific medical interpreters are not available. Ordinary telephone equipment is used and the interpretation is sequential, with one person speaking in to the equipment which is then handed to the other person to receive the interpretation. The service is thus expensive and does not generate the direct rapport between the two parties.
It is an objective of the invention to overcome, or to at least lower, the language barrier which interferes with necessary communications between a doctor and a patient who do not speak a common language.
It is another objective of the invention to increase the availability and effectiveness of interpretation services, particularly in a hospital environment, thereby to facilitate oral communication between two persons who do not speak a common language.
The present invention achieves the above-identified objectives by utilizing a remote interpretation station connected, either by hardwire or wireless, to doctor and patient headsets and microphones at a user station to enable a remotely located interpreter to simultaneously interpret the doctor's words to the patient in a language that the patient understands, and vice versa. This adaption of simultaneous interpretation to a one on one setting, between a doctor and a patient, with the interpreter remotely located, effectively eliminates the language barrier between the doctor and patient and thereby facilitates the diagnosing and providing of health care services.
According to a preferred embodiment of the invention, the remote simultaneous interpretation station includes a microphone and a speaker (or headset), and a doctor/patient unit, or station. At the remote simultaneous interpretation station, a three position switch determines signal routing to the headset and whether the interpreter listens to the DOCTOR, the PATIENT or BOTH. Similarly, the microphone includes three latched pushbuttons which bear the designations DOCTOR, PATIENT and BOTH. The depressed pushbutton determines outward signal routing of the interpreter's voiced signal. The doctor/patient station includes a "call" button to request simultaneous interpretation services.
In use, with an interpreter called and the doctor and patient ready to communicate, the interpreter positions the headset switch to BOTH and depresses the BOTH pushbutton for the microphone. Basically, this puts the system in a "conference" call mode, wherein sequential interpretations may occur because each of three parties hears all the other parties. At this time, the interpreter sequentially explains the procedures to both the doctor and the patient. In this mode, the interpreter hears his or her own voice. Due to familiarity with the system, it may eventually not be necessary to provide introductory instructions to the doctors.
After the introduction, one of the parties, usually the doctor, will begin speaking. The system routes the voiced signals of the doctor in a first language to the remotely located simultaneous interpretation station. The interpreter hears the signals if the headphone switch remains positioned at BOTH. The interpreter interprets the doctor's voiced signals into a second language which is understood by the patient. If desired, to reduce background noise, the interpreter may use the DOCTOR setting to listen to the doctor. With the PATIENT microphone pushbutton depressed, the system routes the interpreter's voiced signals to the patient.
When the doctor is finished speaking, the interpreter changes the position of the headphone switch to PATIENT (if it was on DOCTOR) or leaves the headphone switch on BOTH so that incoming voiced signals representing a response from the patient can be heard. The interpreter also depresses the DOCTOR pushbutton to route to the doctor a voiced interpretation of the patient's response. When the interpreter's microphone switch is set to either DOCTOR or PATIENT (via the pushbuttons), the interpreter does not hear his or her own voice. Thus, the BOTH designation serves as an immediate indication to the interpreter that a different pushbutton must be depressed, since neither the doctor nor the patient should hear the other's voice at full volume, nor should the interpreter hear his own voice during simultaneous interpretation.
If the interpreter chooses to listen to the doctor and the patient on solely the DOCTOR and PATIENT settings, respectively, without using the BOTH designation for listening, the three position headset switch and the pushbuttons may be ganged together so that switching of the headset switch to DOCTOR or PATIENT automatically actuates the microphone pushbuttons to select PATENT or DOCTOR, respectively.
If desired, to further simplify the job of the interpreter, the call button may be used by the doctor and patient to signal to the interpreter that the voiced signal has ended, and that a voiced response from the other party is now expected. Alternatively, the interpreter stations may include a camera so that he interpreter can make this determination simply by watching the doctor and patient.
Because interpretation is simultaneous, the doctor and the patient eventually become unaware of the language barrier between them. The system creates the impression that the doctor and patient are actually holding a direct conversation, without a third party listening. Applicant's studies show that, compared to sequential interpretation, use of simultaneous interpretation in a medical environment has increased the time spent during the initial history-taking portion of a doctor/patient examination. It is believed that his increase in time represents a greater rapport between the doctor and patient.
The present invention facilitates the use of simultaneous interpretation in the context of such doctor/patient oral communications, and thereby overcomes or significantly reduces the language barrier between the doctor and patient. The present invention also increases the availability and effectiveness of simultaneous interpretation.
Applicant's above-cited parent application, which is expressly incorporated by reference herein, in its entirety, discloses a simultaneous interpretation system which heightens the interpreter's awareness of the on/off status of his or her microphone, and which facilitates oral prompting between a pair of simultaneous interpreters working as a team in a booth. This previously disclosed system is particularly suitable for conferences involving multiple participation and multiple languages, with the participants located at a single site.
The present invention employs a substantial number of the features of the parent application, but it is more particularly suited to oral communication between two persons who do not speak or understand a common language. While the present invention is particularly suitable for patient doctor communications, particularly in a hospital, it is not limited to medical applications, or to two persons present in the same room. In fact, in addition to a remotely located interpreter (operatively connected by hardwire or wireless) the two persons wishing to communicate may also be separate and remote from each other with a wire or wireless audio connection therebetween.
These and other features of the invention will be more readily understood in view of the following detailed description and the drawings.